Fundamental Analysis

Ozempic and the Substitution Trade

The diabetes drug Ozempic has made headlines recently as the secret behind several slimmed-down stars of the Bravo network’s “Real Housewives” franchise. Tabloid fodder doesn’t usually matter to investors, but the story of Ozempic is one worth reading.

Portrait of David Glickman, Analyst and Portfolio Manager at Harding Loevner.
Portrait of Patrick Todd, Analyst and Portfolio Manager at Harding Loevner.
Co-Deputy Director of Research David Glickman, CFA and Analyst and Portfolio Manager Patrick Todd, CFA contributed research and viewpoints to this piece.

The diabetes drug Ozempic has made headlines recently as the secret behind several slimmed-down stars of the Bravo network’s “Real Housewives” franchise. Tabloid fodder doesn’t usually matter to investors, but the story of Ozempic is one worth reading.

The twist is that Ozempic, a trade name for semaglutide, is a diabetes drug, not an obesity drug. Semaglutide is however effective in inducing weight loss; its creator Novo Nordisk markets a separate version called Wegovy specifically for obesity. Wegovy became so popular there were shortages of it, so doctors began prescribing Ozempic “off label” for a condition other than its intended use. That popularity fueled Novo Nordisk shares and this month it pushed past LVMH as Europe’s most valuable company.

Ozempic being used as a substitute for a different medical treatment goes beyond Novo Nordisk selling the same drug under different names. Ozempic could also serve as a replacement for people contemplating bariatric surgery, since it stands to reason that anybody considering surgery would likely be willing to try a less-invasive treatment. Recently, Intuitive Surgical noted a slowdown in the growth of bariatric surgical procedures because of the increasing use of drugs such as Ozempic. “Some customers have indicated that they are seeing increased patient interest in weight-loss drugs,” Intuitive chief financial officer Jamie Samath said in July.

Given that obesity is the most important reversible factor contributing to sleep apnea, there’s a chance Ozempic and similar drugs could become a treatment for that, too. Eli Lilly, for instance, is running a study of its type 2 diabetes medication Mounjaro, which is in the same drug class as Ozempic/Wegovy, as a possible treatment for sleep apnea. Results are due in March 2024.

That could be a problem for a company like ResMed, which makes sleep-apnea treatments with its CPAP (continuous positive airway pressure) therapy. These are machines that force air through the patient’s nasal passages, enabling better sleep. For patients, the issue may go beyond just which treatment is more effective.

Cost will be a big factor. Medicare and private insurers cover Ozempic for its commercially approved use, diabetes, but not for weight loss or other off-label uses. That could be important because the cost of Ozempic can be considerable (without insurance, it can cost about $1,000 a month). For sleep apnea patients, ResMed products may end up delivering the same or better results at a much lower price.

ResMed CEO Michael Ferrell in fact seems to welcome the new attention, since sleep apnea tends to be an underdiagnosed condition. Ozempic and similar drugs could bring potential patients “into the funnel,” he said on a conference call, while issues like cost and side effects will limit any hit to sales caused by the drugs. “That’s good for us, too,” he said. ∎

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